Antidepressants for Children and Adolescents

Depression is a serious illness at any age, but when it impacts young people, it affects the entire family. The disorder interferes with a healthy social life, disrupts academic performance, causes problems with sleeping and eating, and can lead to serious physical and mental problems down the road.

The National Institute of Health estimates that in the United States, major depressive disorder affects approximately five percent of adolescents.

Since the 1980s, prescription antidepressant medications have been a great benefit for adults. However, use of the meds for children and adolescents is wrapped in controversy due to a concern that antidepressants may actually increase the risk of suicidal behavior.

For parents, the decision whether not a depressed offspring should take antidepressants is a difficult one. However, many experts believe that parents shouldn’t be deterred from considering medication when the situation warrants such treatment. Understanding the risks and benefits can help families make wise, informed decisions.

Antidepressants for Children and Adolescents: Black Box Warnings

In 2004, the U.S. Food and Drug Administration (FDA) required manufacturers to include “black box” statements on antidepressant medication packages. The statements concerned the possibility of increased risk of suicide and suicidal behavior, as well as agitation and hostility in children and adolescents. In 2006, the warning was extended to include young adults to age 25.

The requirement was based on an extensive review of controlled clinical trials involving 4,000 participants. The trials indicated that four percent of those taking the meds experienced suicidal thinking or behavior – about double the amount of study participants taking placebos, particularly in the first few months of treatment. However, there were no actual suicides.

Even though no suicides took place, the government concluded that the possibility of suicidal thinking and behavior was serious enough to warrant the Black Box warning so parents could consider any possible risk.

Black Box Warnings and Unintended Consequences

Many professionals believe that the Black Box warnings backfired, and as a result, adolescents frequently aren’t receiving adequate treatment for depression.

Many blame the media’s overreaction, claiming that exaggerated reports actually made the situation much worse. Harvard University stated that media coverage and the resulting fear prompted decreased use of the meds, which was followed by a significant rise in suicide attempts.

The FDA has since stated that the intention of the warnings wasn’t to imply that medications cause more suicide attempts, and admitted problems with the way the message was communicated to the public. It wasn’t the government’s intention to make the drugs less available, but to ensure that use of the medications in children and adolescents is closely monitored and that any changes be reported immediately.

One major study funded in part by the National Institute of Mental Health (NIMH), indicated that the benefits of antidepressant therapy outweighs the risks, and that antidepressants used in conjunction with mental health therapy shows the greatest reduction in suicidal thinking and behavior in adolescents.

Tough Decisions for Parents

Antidepressant medications are generally safe, effective, and well-tolerated, and increases in suicidal thoughts and behavior affects only a small percentage of youth. Thus, any risk of using medications must be weighed with the risks of allowing severe depression to remain untreated.

Good screening techniques are critical to determine whether medications are appropriate. All risk factors should be considered, including family history of mental illness and presence of other mental health disorders such as bipolar disorder or ADHD. An accurate diagnoses requires a comprehensive evaluation; a 15-minute check-up is insufficient for such an important decision.

Adolescents who take antidepressant medications should be carefully monitored and parents should watch for any changes, including problems at school or with friends, withdrawal, sleeplessness, unusual agitation or panic attacks, increased anxiety or talk of suicide, especially within the first month of taking the meds. Medical monitoring should be ongoing. Youths with substance use disorders should be carefully evaluated, and may need drug and alcohol treatment or rehab.

Antidepressant medications should never be stopped abruptly, and shouldn’t be discontinued without medical support.

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